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General NPI Number Information
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NPI Number | 1376626655
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Entity Type | Individual
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Provider Name | MITCHELL IRA BORISKIN FNP
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 48134 HIGHWAY 58
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City | OAKRIDGE
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State | OR
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Zip | 97463-9601
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Country | US
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Telephone | 541-640-7625
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Fax |
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Provider Business Mailing Address
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Address Line | 1292 HIGH ST STE 224
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City | EUGENE
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State | OR
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Zip | 97401-3238
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Country | US
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Telephone | 541-500-2500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 85073033N1
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License Number State | OR
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